Reusable elastomeric respirators are one option being considered to conserve and sustain the vital healthcare respirator supply chain during pandemics and other public health emergencies. Determinants of appropriate elastomeric respirator use in the healthcare setting however, have not been fully described. We will characterize these determinants by evaluating a large University Medical Center respiratory protection program (RPP) that currently includes hundreds of elastomeric respirator users in both inpatient and outpatient settings. Data will be derived from the input of: 1) decision makers determining respiratory selection and program design; 2) respirator users (healthcare workers (HCW)) and 3) economic analysis comparing costs of an elastomeric versus a disposable respirator program. We will perform: i) key informant interviews of decision makers-- Directors of Employee Health, Infection Control, Safety, and Human Resources-- regarding their rationale for elastomeric device selection which will inform and refine the focus and content of a ii) questionnaire to include evidence-based respirator performance requirements (functionality, maintenance, re-use, usability, and durability). Using this questionnaire, a survey of a larger pool of decision makers at the 11 independent facilities within our University System will be performed. To assess user input, we will compare responses to an iii) online survey of current HCWs using elastomeric, compared to disposable N95 respirators regarding usability, comfort and wearability. Finally, we will perform an iv) economic analysis comparing elastomeric versus disposable respirators from modeled scenarios using factual cost data. The work is significant in that it studies a worker population that encounters tuberculosis and other airborne infectious agent exposure regularly, allowing the truest test of RPP effectiveness. This project is innovative as it exploits the real-world experience of a multi-site respiratory protection program which includes > 500 elastomeric respirator users across a variety of patient care environments. This exceptional research to practice (R2P) opportunity uses to advantage our functioning RPP, unique in the region, and perhaps the country, to inform policy-makers nationally in crafting evidence-based decisions about the protection of healthcare workers in future public health emergencies. .